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Upper lid blepharoplasty

Upper lid blepharoplasty 

Blepharoplasty comes from the Greek words blepheron, meaning eyelid, and plassein, meaning to form. It essentially refers to the reshaping of the eyelids and is used to describe plastic surgery to the eyelids. Upper eyelid blepharoplasty primarily involves removal of excess skin but this can be combined with a range of other procedures including refashioning of the upper eyelid skin crease or reshaping the upper eyelid fat. A thorough consultation with an experienced surgeon is therefore essential to determine which procedures best suit an individual’s eyes and concerns. This is often termed a “customised blepharoplasty”.

Upper eyelid blepharoplasty does require a cut to be made along the length of the upper eyelid but this is well hidden in the skin crease making it almost invisible to most onlookers. Occasionally it may have to extend outward into a crow’s foot line.

The incisions in upper eyelid blepharoplasty can either be made with a blade or a cutting laser. There are advantages and disadvantages to both techniques and which is used is largely a question of the surgeon’s preference.

Various methods are used to close the wounds during upper eyelid blepharoplasty. Most commonly permanent sutures, such as nylon or prolene, are used to close the skin as these cause the least skin reaction. Sometimes, absorbable sutures, such as vicryl, are used for deeper stitching, and alternative substances, like tissue glue, can be used to close wounds. The choice of sutures does depend on the type of surgery you are having and your surgeon’s preference.   

Upper eyelid blepharoplasty can be performed under local anaesthetic only (with the patient completely awake and an injection into the eyelids); under local anaesthetic with sedation (the patient is awake but is given something to make them feel very relaxed); or sometimes under full general anesthetic with the patient asleep. Local anaesthetic of some sort is preferable to general anaesthetic as the recovery is faster and the patient is able to open and close their eyes, allowing a better assessment of the upper eyelid contour and skin fold. Surgery to both upper eyelids usually takes between 60-90 minutes depending on what is being done. The surgery is usually performed as a daycase operation.

Recovery from the procedure usually takes two weeks. During the first week both eyelids will appear swollen and bruised, and are likely to feel stiff and itchy. By the end of the first week when the sutures have come out, the eyelids feel much more comfortable and the swelling and bruising is greatly reduced. By the end of the second week most patients feel ready to face the world without sunglasses on.

Most patients are very happy with the results of upper eyelid blepharoplasty surgery. In general, the surgery lasts several years and does not need repeating. However, the eyelids and face do continue to age throughout a person’s life, and, depending on an individual’s aging process and their preferences, some people do chose to have additional upper eyelid blepharoplasty surgery later on in their life. This does not usually pose any problems if performed appropriately.

Benefits of upper eyelid blepharoplasty

Upper eyelid blepharoplasty is a very successful procedure with a high level of patient satisfaction. To quote William Shakespeare: “The eyes are the windows to your soul” and the facial feature that we pay most attention to. This is confirmed in modern society by the fact that the most popular cosmetic procedure is a blepharoplasty. Tattler Beauty and Cosmetic Surgery Guide recommended “ if you only have one anti-ageing operation, an eyelid lift is the one to choose”.
Upper eyelid blepharoplasty is usually performed to increases the amount of upper eyelid visible (termed the upper eyelid “show”) and to get rid of hooding. This lightens the eyes and makes them appear bigger, which in turn makes the face look more refreshed, more open and more youthful. In addition, unsightly bulkiness of the upper eyelid, e.g. fat bulges, can be smoothed out. For many people, being able to change their upper eyelid contours in this way is extremely beneficial, especially with the pressures faced in our modern, highly visual world.  In addition, some women feel that they would like to increase the amount of visible eyelid they have in order to apply make up more effectively, or because they perceive that bigger eyelids are more attractive.  

Risks of upper eyelid blepharoplasty

As well as appreciating the many benefits of upper eyelid surgery, it is essential that patients are fully aware of the risks before undertaking any kind of surgery. Upper eyelid blepharoplasty is a very successful procedure with a high level of patient satisfaction. However, as with all surgical procedures it does carry some small risks which all patients need to be aware of.
Whenever the skin is cut, as necessitated by upper eyelid blepharoplasty surgery, there is a risk of bleeding, scarring and infection. However, the eyelid wounds are small and therefore these are not usually major problems. Many patients are understandably concerned about eyelid scarring. In general, the scars from upper eyelid blepharoplasty surgery are well hidden in the skin fold or crows foot line and not a problem. However, some people may have an unusual scarring reaction or feel that their scars are more visible than they anticipated, particularly at the outer corners of both eyes where the skin is thicker. It can take a full year for scars to completely mature and therefore it is always best to let things settle fully prior to considering any form of further treatment. Massaging the scars regularly with an unperfumed moisturizing cream can help to speed up scar maturation.
Other risks of blepharoplasty surgery do include asymmetry of the upper eyelids in terms of height or contour.

Most people do have some difference in their upper eyelids and it is likely that there will be some trivial difference between their eyelids after surgery. However, occasionally this can be more noticeable and require further treatment.

Whenever skin is removed from the upper eyelid there is a risk of poor eyelid closure. Most patients do have stiff eyelids straight after surgery and eyelid closure can be weakened immediately after surgery. However, this should completely settle over the next few weeks. Rarely, people can have a prolonged problem with eyelid closure that needs further treatment.

Poor eyelid closure can cause dry eye and all patients are given moisturizing drops after surgery to keep the eyes moist. However, most people are able to stop these drops around two weeks after surgery as their eyes are comfortable by then.

Although it seems obvious, blepharoplasty surgery will alter the way you look and patients need to be prepared for this. Similarly, patients need to have reasonable expectations of surgery other wise they will be disappointed.

Finally, any surgery around the eye does have the potential risk of causing some visual disturbance. This is extremely unlikely in upper eyelid blepharoplasty as the eye itself is not involved in any way but is something that patients should be aware of.

Limitations of upper eyelid blepharoplasty

Blepharoplasty will not change the underlying tone or colour of your skin. In addition, whilst it may improve some wrinkles, it will not get rid of crows feet wrinkles or some of the fine wrinkling of aged skin. In addition, the upper eyelid will continue to age over time with the possibility of additional deflation, skin excess and loosening of the skin crease.

Middlemead Medical Ltd trading as Eyelid Clinic registered in England no:11279604.Registered Office: 20 Coxon Street, Spondon, Derby DE21 7JG